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Environmental Health Department <br />1. <br />2 <br />3. <br />4. <br />5. <br />440Total Attendance:6. <br />2. <br />3. <br />4. <br />dumpsters provided by hospital5. <br />6. <br />APPLICATION <br />1. <br />2. <br />2g/?Event Coordinator: Date: <br />0 Yes <br />0 Yes <br />0 Yes <br /> No <br /> No <br /> No <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EH0 16-02 Page lot 11 TEMP EVENT APP <br />07/3/17 <br />a) <br />b) <br />c) <br />d) <br />e) <br />TEMPORARY EVENT APPLICATION <br />To be completed and signed by Event Coordinator, then returned to the Environmental Health Department with all <br />of the Food Vendor’s Applications no later than two weeks prior to event <br />SAN JOAQUIN <br />— COUNTY — <br />Submit the following to the Environmental Health Department two weeks prior to the event: <br />Temporary Event Application <br />Application Review Fee of $152 <br />Temporary Food Vendors Applications for each booth <br />Temporary Event Site Plan <br />Food Vendor List <br />Number of dumpsters: <br />Disposed of at the food truck's commissary <br />If the event is selected for inspection, the Event Coordinator will be billed for inspection time: <br />• $152 per hour (weekdays 8:00 am to 5:00 pm) <br />• After regular business hours (weekday, weekends and holidays) the inspection is charged at the <br />hourly rate, calculated at one and one half times ($228 per hour) <br />This application is to be completed and signed by the Event Coordinator, then returned to the <br />Environmental Health Department with all Food Vendor’s Applications no later than two weeks prior to the <br />event. <br />I understand that as a temporary event coordinator, I am responsible for meeting California State <br />• standards and the Environmental Health Department policies and procedures. <br />UTILITIES <br />1.Is potable water supplied and available for each food vendor: <br />Is electricity supplied and available for each food vendor: <br />Are janitorial facilities available: <br />Number of toilets provided: 'nsi^e hospital <br />Name of sanitary garbage disposal company: <br />Method of disposal of liquid waste for food booths: <br />Approximate attendance at peak time: 220 Average Age: 35 <br />GENERAL EVENT FILE INFORMATION <br />Name of Event: Kaiser Manteca Lunch/Dinner <br />Date(s) of Event: Wednesday, May 22nd Time of Event:11 am-2pm & epm-Spm <br />Location: 1721 W. Yosemite Ave., Manteca, Ca. <br />Event Coordinator (Name): SactoMoFo Telephone: (91Q-400-3978 <br />Mailing Address: 1017 L St. #230, Sacramento, Ca. 95814 <br />Number of Food Booths: 3